REBEL EM

MAY 29, 2023

Paper: Ibarra-Estrada, M et al. What They Did: Single-center, parallel, double blind, randomized controlled trial performed in a medical-surgical ICU (Mexico) Both groups received: Adjunctive vasopressin initiated at a dose of 0.03 Limited, small studies on its use in septic shock do not make a clear argument for use. Crit Care 2023.

ICU 145

ICU ALS Epinephrine OR 145

The Skeptics' Guide to EM

JULY 16, 2022

Date: July 16th, 2022 Reference: Lamontagne F et al. Date: July 16th, 2022 Reference: Lamontagne F et al. She is admitted to the intensive care unit (ICU) for septic shock. The ICU team is considering using Vitamin C therapy for this patient. Reference: Lamontagne F et al. Guest Skeptic: Dr. Salim R.

ICU 100

ICU ALS Critical Care Emergency Department 100

EMDocs

NOVEMBER 29, 2023

EBM Update: Steroids in Severe CAP and CT in Post ROSC OHCA #1: Dequin PF, Meziani F, Quenot JP, et al; CRICS-TriGGERSep Network. Question: In adult patients admitted to the ICU with severe CAP, does hydrocortisone compared to placebo reduce 28-day all-cause mortality? 2022 Aug;48(8):1009-1023. N Engl J Med. Intensive Care Med.

ICU 98

ICU CAD ALS OR 98

Broome Docs

OCTOBER 31, 2022

Ketamine vs etomidate in ICU intubation ? 2022 Jan;48(1):78-91. The PEACH trial: No body had a fit, so… we have no clue Peter-Derex L, Philippeau F, Garnier P, et al. 2022 Sep;21(9):781-791. PMID: 30206143 Less is more when it comes to intravenous fluids de-Madaria E, Buxbaum JL, Maisonneuve P, et al.

E-9-1-1 52

E-9-1-1 Defibrillator ICU Critical Care 52

The Skeptics' Guide to EM

JANUARY 15, 2022

Date: January 16th, 2022 Reference: Matchett, G. Date: January 16th, 2022 Reference: Matchett, G. Etomidate versus ketamine for emergency endotracheal intubation: a randomized clinical trial. Etomidate versus ketamine for emergency endotracheal intubation: a randomized clinical trial. Reference: Matchett, G.

Emergency Medical Services 109

Emergency Medical Services Firefighter Critical Care Paramedic 109

Pediatric EM Morsels

MARCH 17, 2023

Ahmed 2008, Meyers 2022) Of course, treat any other systemic symptoms (like respiratory failure, hypotension) as you typically would. If you are managing a snake bite from a snake that does not typically reside in the U.S., please utilize other resources and local Toxicology experts for help with management protocols.

Frozen Plasma 130

Frozen Plasma Plasma First Aid OR 130

EMDocs

FEBRUARY 20, 2024

Fluids in Pancreatitis #1 : de-Madaria E, Buxbaum JL, Maisonneuve P, et al; ERICA Consortium. 2022 Sep 15;387(11):989-1000. 2: Li XW, Wang CH, Dai JW, et al. 2: Li XW, Wang CH, Dai JW, et al. These videos will cover post summaries, take homes on clinical condition, and EBM/guideline literature updates. N Engl J Med.

E-9-1-1 98

E-9-1-1 ICU ALS OR 98

EMDocs

NOVEMBER 29, 2023

EBM Update: Fluids in Pancreatitis, Hypertriglyceridemic Pancreatitis #1: de-Madaria E, Buxbaum JL, Maisonneuve P, et al; ERICA Consortium. 2022 Sep 15;387(11):989-1000. 2: Li XW, Wang CH, Dai JW, et al. 2: Li XW, Wang CH, Dai JW, et al. Today we focus on pancreatitis. N Engl J Med. to 9.8L) Moderate: 5.5L (Range 4.0

E-9-1-1 94

E-9-1-1 ICU ALS OR 94

EMS 12-Lead

AUGUST 22, 2022

A 65 y/o Female was admitted to the ICU for septic shock. The combination of prolonged QT and deep T wave inversion throughout the precordium is typical of Takotsubo syndrome, or Stress Cardiomyopathy – which can occur in the context of a physiologically distressed ICU patient, further compromising their hemodynamics. Friedman, M.,

E-9-1-1 130

E-9-1-1 Coronary ALS ICU 130

REBEL EM

OCTOBER 5, 2023

Paper: Dequin P, Meziani F, Quenot J, et al. ClinicalTrials.gov: NCT02517489 7 Clinical Question: In adult patients with severe community-acquired pneumonia admitted to the ICU, does early hydrocortisone treatment, compared to standard therapy, reduce mortality at 28 days? ICU-acquired infections were observed in: 9.8%

Critical Care 94

Critical Care ICU E-9-1-1 ALS 94

Dr. Smith's ECG Blog

FEBRUARY 2, 2024

His temperature was brought back to normal over time in the ICU. Rituparna et al — as well as Chauhan and Brahma ( Int. We've discussed Osborn Waves ( both ischemic and hypothermic ) — on a number of occasions in Dr. Smith's ECG Blog ( Please check out My Comment at the bottom of the page in the February 8, 2022 post ).

ICU 138

ICU OR ALS ED 138

REBEL EM

AUGUST 12, 2024

Epub 2022 Aug 28. The authors of this study sought to test the hypothesis that intravenous amino acid therapy would lead to a lower occurrence of postoperative AKI when compared to placebo. Paper: Landoni G. The PROTECTION trial. Contemp Clin Trials.

ICU 81

ICU Operating Room Critical Care ALS 81

Emergency Medicine Ireland

MAY 27, 2024

Vasopressin has some animal data suggesting it causes less rise in PVR than our beloved noradrenaline but take that with an appropriately loosely defined portion of salt given that animal data is not ICU patients. Atrial fibrillation is something of a right of passage in the ICU. 2022 ESC Guidance McLaughlin, V. Souza, R. &

Critical Care 52

Critical Care ICU OR ALS 52

REBEL EM

JUNE 8, 2023

Paper: Singer S, et al. 2022 Sep 5. References: Singer S, et al. 2022 2022 Sep 5. PMID: 36108346 Cole JB, et al. PMID: 31270748 Maheshwari K, et al. The relationship between ICU hypotension and in-hospital mortality and morbidity in septic patients. PMID: 29872882 Jones AE, et al.

Epinephrine 98

Epinephrine Emergency Department ALS Critical Care 98

EMDocs

AUGUST 15, 2023

Published April 15, 2022. Accessed May 7, 2022. StatPearls Publishing; 2022. Accessed May 17, 2022. link] Kanaan NC, Ray J, Stewart M, et al. Accessed May 7, 2022. Accessed May 7, 2022. Accessed May 7, 2022. Accessed May 7, 2022. Am J Hosp Pharm. 1991;48(10):2190-2196. In: StatPearls.

Emergency Department 98

Emergency Department OR EMS ED 98

EMDocs

JUNE 3, 2023

Patients receiving thrombolysis will require ICU admission for neurologic monitoring. Rosh Review Website Link Further Reading [link] [link] [link] [link] [link] References: Stanislavsky A, Baba Y, Hacking C, et al. Updated 2022 May 8]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Updated 2022 Jul 25].

EMS 98

EMS ALS OR ED 98

EMDocs

JANUARY 16, 2024

He requires low-dose epinephrine to maintain his mean arterial pressure (MAP) in the 60s mmHg and is transported to the cardiothoracic (CT) ICU. Carsten L, et al. ASAIO Journal: February 2022 – Volume 68 – Issue 2 – p 153-162. Monika BM, Martin D, Balthasar E, et al. Forti A, Brugnaro P, Rauch S, et al.

Defibrillator 110

Defibrillator CPR Epinephrine Life Support 110

REBEL EM

AUGUST 14, 2023

Article: Liu S, Yao C, Xie J, et al. They consecutively enrolled 1,817 ICU patients from 45 sites across China. Population: Inclusion Criteria: Age 18-75 years old SOFA score 2-13 Admitted to the ICU with a diagnosis of sepsis 3.0, “ Life-threatening organ dysfunction caused by a dysregulated host response to infection.”

ICU 98

ICU EMS OR ALS 98

EMDocs

OCTOBER 21, 2023

All patients who receive thrombolytics for ischemic stroke should be admitted to a neurosurgical, neurologic, or medical ICU for management and monitoring, as this is shown to decrease mortality and length of stay. References: Gaillard F, Glick Y, Tatco V, et al. Updated 2022 Dec 22]. Updated 2022 Oct 15]. Arch Neurol.

EMS 98

EMS ALS OR ACS 98

REBEL EM

OCTOBER 31, 2022

Fujii 2022, Sevransky 2021) Contrary to the above trial, another RCT investigated patients in the ICU with sepsis and acute respiratory distress syndrome. Clinical Question: Does high-dose vitamin C improve survival and/or persistent organ dysfunction rates in septic patients in the ICU on vasopressors? N Engl J Med 2022.

ICU 52

ICU ALS OR EMS 52

REBEL EM

MARCH 27, 2023

2 Finally the settings initiated early in a patient’s care are often carried forward unchanged into their hospital and ICU stay. Paper: Owyang CG, et al. 2019 Aug; PMID: 30954692 Clinical Question: What is the impact of system factors in the implementation of standard-of-care LPV in critically ill ED patients admitted to the ICU?

Emergency Department 52

Emergency Department ICU Critical Care EMR 52

REBEL EM

NOVEMBER 6, 2023

Paper: Hiruy A, et al. So with yet another confounding variable added (sicker patients at baseline in methylene blue group), the comparison of these two medications is yet again even more difficult There was no difference in ICU and hospital length of stays or hospital mortality between the two groups. REFERENCES: Hiruy A, et al.

Epinephrine 72

Epinephrine ICU ALS OR 72

Broome Docs

MARCH 28, 2024

Great evidence for button battery ingestions (if you are treating a dead pig) Chiew AL, Lin CS, Nguyen DT, Sinclair FAW, Chan BS, Solinas A. 2022 Feb;52:85-91. Although I miss performing the procedure, these days I almost always leave the central line until the patient is stabilized and settled into their ICU bed. Ann Emerg Med.

E-9-1-1 96

E-9-1-1 ICU Emergency Department ALS 96

EMDocs

APRIL 10, 2024

Hemodynamics slowly begin to stabilize, and the patient is transferred to the ICU for further post-cardiac arrest care. McGraw Hill; 2022. doi:10.1136/bcr-2019-233119 Neal JM, Barrington MJ, Fettiplace MR, et al. The patient remains hemodynamically unstable, and bolus of 1.5 mL/kg is given followed by a continuous infusion.

E-9-1-1 111

E-9-1-1 Plasma Epinephrine Overdose 111

REBEL EM

MARCH 23, 2023

Treatment options for alcohol withdrawal include benzodiazepines such as lorazepam, diazepam, or chlordiazepoxide, gabapentin, and phenobarbital (Buell et al.). Phenobarbital can be used as a monotherapy or in combination with benzodiazepines to treat alcohol withdrawal (Hawa et al.). Paper : Hawa F et al.

ICU 52

ICU Emergency Department ALS OR 52

REBEL EM

SEPTEMBER 5, 2022

Paper 1: Schmidt HJ et al. PMID: 360027567 [ Access on Read by QxMD ] Paper 2: Kjaergaard J et al. References: Schmidt HJ et al. PMID: 360027567 [ Access on Read by QxMD ] Kjaergaard J et al. A higher MAP may offer advantages due to improved cerebral perfusion pressure, however data is lacking. Liberal O2: 33.9%

ICU 52

ICU ALS OR CPR 52

EMDocs

APRIL 22, 2024

Alerhand et al described ten individual echocardiographic findings of RV strain that suggest PE. Marino’s the ICU book, Wolters Kluwer Health, pgs 105-109, 4th ed., VUMC Emergency Medicine, “RV Strain & TAPSE” YouTube Video [link] Farcy et al. 2022 Sep;24(6):579-581. Epub 2022 Jun 30.

ED 98

ED NARCAN ALS OR 98

REBEL EM

SEPTEMBER 29, 2022

Article: de-Madaria E et al. For More on This Topic Checkout: CorePendium: Pancreatic Disease Internet Book of Critical Care: Acute Pancreatitis EMCrit: Ep333 – The State of Fluids Show with the EMCrit Core Team The Bottom Line: Aggressive or Moderate Fluid Resuscitation in Acute Pancreatitis References: de-Madaria E et al.

ICU 52

ICU ALS Critical Care Emergency Department 52

REBEL EM

AUGUST 31, 2023

Paper: van Baarle FLF et al. ICU: 42.6% vs 0% ICU length-of-stay: 9 days vs 7 days In-Hospital Mortality: 28.2% ICU Mortality: 56.7% Conversely, it may be reasonable to withhold prophylactic platelets for patients in the ICU setting due to trends of lower bleeding risk noted as well as more intensive bleeding monitoring.

ICU 59

ICU ALS OR EMS 59

Don't Forget the Bubbles

JUNE 30, 2023

They found NO difference in drain failure rates ( 11% pigtail vs 13% chest tube P=0.74), total daily volume drained or length of ICU stay between groups. 2022 Dec;57(12):986-993. Trials 23, 384 (2022). Kulvatunyou N, Bauman ZM, Zein Edine SB, de Moya M, Krause C, Mukherjee K, Gries L, Tang AL, Joseph B, Rhee P.

E-9-1-1 139

E-9-1-1 FFP Plasma Emergency Department 139

REBEL EM

FEBRUARY 2, 2023

2 Amiodarone is commonly known for its anti-arrhythmic properties and a commonly used agent in the Intensive Care Unit (ICU). Paper: Mason JM, et al. These results were corroborated with other another study by Gritensko et al. References Mason JM, et al. 2022 Sep 7. 2018, PMID: 30571262 Gritsenko, Diana, et al.

Emergency Department 52

Emergency Department ALS Critical Care ED 52

Don't Forget the Bubbles

JUNE 17, 2024

The team sits down for a hot debrief once the patient is stabilised and transferred to the ICU. 2022 May 12;46(3):319-24. Frich JC, Brewster AL, Cherlin EJ, Bradley EH. While you are leading the resuscitation, one of your senior colleagues belittles a junior staff member for struggling to site an IV line. Edmondson, Amy C.

E-9-1-1 105

E-9-1-1 Critical Care CPR ICU 105

REBEL EM

JULY 25, 2022

Click here for Direct Download of the Podcast Paper: Russell DW et al. References: Russell DW et al. PMID: 35707974 [ Access on Read by QxMD ] Janz DR et al. REBEL Cast Ep111: The PrePARE II Trial – Fluid Bolus Prior to Intubation? No Bolus: 18.2% Absolute difference 2.8%; 95% CI -2.2% to 7.7%; p = 0.25 No Bolus: 17.6%

ALS 59

ALS Critical Care ICU OR 59

REBEL EM

NOVEMBER 3, 2022

Matchett 2022). Article: Sharda SC et al. Indian J Crit Care Med 2022. Included studies assessed patients in the emergency department and prehospital setting, which limits the external validity to other treatment areas such as the ICU. PMID: 21373823 Jabre P, Combes X, Lapostolle F, et al. 2011;37(6):901-910.

ALS 52

ALS ICU ED Emergency Department 52

ACEP Now

MAY 9, 2024

Unfortunately, at least 13 deaths were subsequently reported in Miami-Dade County from 2019–2022, the three years immediately following the implementation of the subcutaneous injection regulation. 6 Theoretically, ultrasound guidance should decrease this risk, which formed the basis for the 2022 Florida Medical Board regulation.

Emergency Department 52

Emergency Department Operating Room Critical Care ICU 52

REBEL EM

SEPTEMBER 15, 2022

Paper: Mullens W et al. diuresis NOT natriuresis) A common clinical practice in the ICU is to use a loop diuretic as monotherapy or a loop diuretic in combination with a thiazide diuretic.This can commonly lead to hypernatremia, hypochloremia, and a metabolic alkalosis. References: Mullens W et al. PMID: 21366472 Bart BA et al.

ALS 52

ALS ICU OR EMS 52

ACEP Now

MAY 9, 2024

Taking a different approach than the authors of the AHRQ report, Auerbach et al used a “look back” approach to perform both qualitative and quantitative evaluations of the types and frequencies of errors occurring in hospital settings. After developing encephalopathy and hypoxemic respiratory failure, the patient was transferred to the ICU.

Emergency Department 52

Emergency Department ICU ALS ACS 52